mass extending from the lateral nasal wall to the septum with obliteration of middle meatus. Computed tomography of the sinuses showed a left- sided mass (3.6 x 2.4 x 3.5 cm) with a radioopaque focus at the anterior aspect of a concha bullosa, immediately op- posite the ostium of an opacified maxillary sinus (Figure 1). T1-weighted coronal magnetic resonance imaging of the sinuses revealed a well-defined, expansile lesion with significant homogenous enhancement demonstrated in its inferior portion. Lateral displacement of the lamina papy- racea and left eye and opacification of the left maxillary and ethmoid sinuses were demonstrated (Figure 2). The patient underwent endoscopic surgical removal of the lesion. Histopathology revealed benign respiratory mucosa and areas of trabecular bone consistent with juvenile ossifying fibroma (Figures 3a, 3b). The patient experienced improve- ment of symptoms initially; however, the lesion recurred three months later. Craniofacial resection via combined bicoronal andWeber-Ferguson approaches was performed for definitive resection with good result. DISCUSSION A variant of ossifying fibroma (OF) was first described as a cemento-ossifying fibroma by Menzel in 1872; in 1927, Montgomery first used the term ossifying fibroma. 1,2 OF are benign tumors that can originate anywhere in the cra- niofacial skeleton. OF demonstrates female predominance Figure 2: T1-weighted coronal magnetic resonance, expansile lesion with significant homogenous enhancement.
and is thought to arise from the periodontal membrane, sur- rounding tooth roots, andmost often presents with painless swelling of the mandible or incidental finding on routine dental radiographs. By contrast, juvenile ossifying fibroma (JOF) most often originates outside the tooth root in the maxilla, paranasal sinuses, or orbit. 1,3 This case presented within the middle turbinate in an apparent concha bullosa. There are no previously reported cases of JOF arising from a concha bullosa or middle turbinate. There have only been two previously described cases of OF arising from the middle turbinate. 4,5 JOF is histologically similar to OF, differentiated from the latter by its more locally aggressive behavior, higher rate of recurrence (30%-58%), and early age of onset (most often between 5 and 15 years of age, mean 11.8). The aggressive nature of these lesions tends to represent their proximity to structures, such as the orbit and anterior skull base rather Figures 3a and 3b: Benign respiratory mucosa and areas of trabecular bone consistent with the trabecular variant of juvenile ossifying fibroma. Occasional multi-nucleated giant cells can be found within a stroma of plump fibroblasts. Hematoxylin and eosin stain at 10x and 40x magnification, respectively.
J La State Med Soc VOL 166 May/June 2014 101
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